JUSTIFICATION FOR RE-LOOK CYSTOSCOPY AFTER POSTERIOR URETHRAL VALVE FULGURATION

Authors

  • Gul Nawaz Shifa International Hospital, Islamabad
  • Ijaz Hussain Shifa International Hospital, Islamabad
  • Shujah Muhammad Shifa International Hospital, Islamabad
  • Muhammad Imran Jamil Shifa International Hospital, Islamabad
  • Asad Ur Rehman
  • Nadeem Iqbal Shifa International hospital
  • Saeed Akhter Shifa International Hospital

Abstract

Background: Posterior urethral valve (PUV) is life-threatening congenital anomaly of the urinary tract that results in vesicoureteric reflux, recurrent UTI, voiding dysfunction and renal insufficiency if not treat timely. Endoscopic ablation of posterior urethral valves using cold knife or laser is the current gold standard therapy. Many urologists go for repeat cystoscopy to see residual valve or stricture while others repeat VCUG to measure the posterior to anterior urethral ratio for residual obstruction. In this study, we have standardized by regularly doing re-look cystoscopy at 3 months whether the child is symptomatic or not to see justification for re-look cystoscopy after PUV ablation. Methods: In this prospective study, first 50 cases that underwent posterior urethral valve fulguration were included. Diagnosis of posterior urethral valve was made by voiding symptoms, ultrasonography and confirmed by voiding cysto-urethrogram (VCUG). All children were treated by endoscopic fulguration of posterior urethral valves (PUV) using cold knife as urethral valvotome and were followed clinically for voiding symptoms and with ultrasonography and laboratory test at 3 and 6 months. All patients underwent re-look cystoscopy at three months to see residual valves irrespective of their clinical improvement. Results: Mean age at presentation was 4.9±3.2 years. The most common symptoms were poor stream (76%), straining at voiding (72%), dribbling of urine (54%), fever (42%) and urinary retention (14%). Residual valves on re-look cystoscopy were seen in 78%. Four (8%) patients had urethral stricture on re- look cystoscopy. Conclusion:  We suggest routine re-look cystoscopy after primary fulguration of PUV to pick more residual obstructive valves.Keywords: PUV; Endoscopic fulguration; Residual valve

Author Biographies

Gul Nawaz, Shifa International Hospital, Islamabad

Assisstant Consultant Urology

Ijaz Hussain, Shifa International Hospital, Islamabad

Consultant pediatric urologist Shifa International Hospital, Islamabad

Shujah Muhammad, Shifa International Hospital, Islamabad

Assistant Consultant Urology

Muhammad Imran Jamil, Shifa International Hospital, Islamabad

Assistant Consultant Urology Shifa International Hospital Islamabad

Nadeem Iqbal, Shifa International hospital

Post Graduate Resident Urology

Saeed Akhter, Shifa International Hospital

Prof. and Consultant Urologist Shifa International Hospital

References

Uthup S, Binitha R, Geetha S, Hema R, Kailas L. A follow-up study of children with posterior urethral valve. Indian J Nephrol 2010;20(2):72–5.

Churchill BM, Krueger RP, Fleisher MH, Mardy BE. Complications of posterior urethral valve surgery and their prevention. Urol Clin North Am 1983;10(3):519–30.

Chen WH, Lai MK, Lin GJ, Chu SH. Clinical experience of a posterior urethral valve. J Formos Med Assoc 1994;93(5):383–7.

Gupta SD, Khatun AA, Islam AI, Shameem IA. Outcome of endoscopic fulguration of a posterior urethral valve in children. Mymensingh Med J 2009;18(2):239–44.

Warren J, Pike JG, Leonard MP. A posterior urethral valve in Eastern Ontario - a 30 year perspective. Canad J Urol 2004;11(2):2210–5.

Babu R, Kumar R. Early outcome following diathermy versus cold knife ablation of posterior urethral valves. J Pediatr Urol 2013;9(1):7–10.

Menon P, Rao KL, Vijaymahantesh S, Kanojia RP, Samujh R, Batra YK, et al. Posterior urethral valves: morphological normalization of posterior urethra after fulguration is a significant factor in prognosis. J Indian Assoc Pediatr Surg 2010;15(3):80–6.

Gupta RK, Shah HS, Jadhav V, Gupta A, Prakash A, Sanghvi B, et al. Urethral ratio on voiding cystourethrogram: a comparative method to assess success of posterior urethral valve ablation. J Pediatr Urol 2010;6(1):32–6.

Bani Hani O, Prelog K, Smith GH. A method to assess posterior urethral valve ablation. J Urol 2006;176(1):303–5.

Sarhan O, El-Ghoneimi A, Hafez A, Dawaba M, Ghali A, Ibrahiem el-H. Surgical complications of posterior urethral valve ablation: 20 years’ experience. J Pediatr Surg 2010;45(11):2222–6.

Greenfield SP. Posterior urethral valves--new concepts. J Urol 1997;157(3):996–7.

Kousidis G, Thomas DF, Morgan H, Haider N, Subramaniam R, Feather S. The long-term outcome of prenatally detected posterior urethral valves: a 10 to 23-year follow-up study. BJU Int 2008;102(8):1020–4.

Mirshemirani A, Khaleghnejad A, Rouzrokh M, Sadeghi A, Mohajerzadeh L, Sharifian M. Posterior Urethral Valves; A single Center Experience. Iran J Pediatr 2013;23(5):531–5.

Malik MA, Javed Sial SH, Iqbal Z. Posterior urethral valves. Professional Med J 2005;12(4):473–8.

Sudarsanan B, Nasir AA, Puzhankara R, Kedari PM, Unnithan GR, Damisetti KR. Posterior urethral valves: a single center experience over 7 years. Pediatr Surg Int 2009;25(3):283–7.

Oktar T, Salabas E, Acar O, Atar A, Nane A, Ander H, et al. Residual valve and stricture after posterior urethral valve ablation: How to evaluate? J Pediatr Urol 2013;9(2):184–7.

Imaji R, Dewan PA. Congenital posterior urethral obstruction: re-do fulguration. Pediatr Surg Int 2002;18(5-6):444–6.

Lal R, Bhatnagar V, Mitra DK. Urethral strictures after fulguration of posterior urethral valves. J Pediatr Surg 1998;33(3):518–9.

Basu AK, Banerjee S, Haque J, Chakravarty US, Ghosh A, Mitra D, et al. Posterior urethral valves–report of a single private clinic in Kolkata. J Indian Assoc Pediatr Surg 2003;8(3):144–7.

Crooks KK. Urethral strictures following transurethral resection of posterior urethral valves. J Urol 1982;127(6):1153–4.

Choudhury SR, Chadha R, Puri A, Prasad A, Sharma A, Kumar A. Clinical spectrum of posterior urethral valve obstruction in children. J Indian Assoc Pediatr Surg 2003;8(3):148–52.

Published

2017-01-25

Issue

Vol. 29 No. 1 (2017): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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